Can’t Trust Your Gut? IBS-D Strategies for Fewer Flare-Ups and More Freedom (with guest Beth Rosen, MS, RD)

Part 2 of the IBS-D Series

We sit down with GI dietitian Beth Rosen to talk about her lived experience with IBS-D, and how the absence of a clear diagnosis and effective treatment plan early on led to frustration and unnecessary food restriction. 

With the right diagnosis and support, she was able to shift toward a clearer path, building a sustainable, flexible approach to eating and symptom management. 

We share real-world strategies for identifying triggers, eating enough without panic, and using gut-brain tools so symptoms don’t run the show.

• Beth’s IBS-D origin story after C. diff and the missteps that delayed care
• Why “everything looks normal” needs context plus a plan
• Building an IBS story document to speed up appointments and strengthen self-advocacy
• Common IBS-D triggers and why broad food cuts can backfire
• Fructans, lactose, gluten, and the value of a targeted approach
• Coffee variables to consider including caffeine dose and acidity
• Digestive enzymes as practical support when appropriate
• Dining out tactics like menu scouting, calling ahead, and simple safe orders
• Travel and social scripts that protect privacy and reduce stress
• Beth's IBS toolbox picks: adequate + regular meals, targeted fiber, hydration, modified low FODMAP, gut-brain strategies
• Diaphragmatic breathing for urgency (Check out Dr. Riehl's video on diaphragmatic breathing, here.)

Other resources from our guest, Beth Rosen MS, RDN:

Hot off the press: Gut Goals - the book for IBS patients, by Beth Rosen!

The EDGI Training Project - the book and resources for practitioners on the intersection of ED and GI 

Learn more about Beth: Beth Rosen's website  

This episode has been sponsored by Salix Pharmaceuticals. 

Don’t forget to subscribe, rate, and leave us a comment. You can also follow us on social media, instagram @theguthealthpodcast, where we’d love for you to share your thoughts, questions, and experiences. 

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Transcript

Welcome And IBS-D Series Setup

Kate Scarlata, MPH, RDN 0:00

This podcast is sponsored by Salix Pharmaceuticals. Maintaining a healthy gut is key for overall physical and mental well-being. Whether you're a health conscious advocate, an individual navigating the complexities of living with GI issues, or a healthcare provider, you are in the right place. The Gut Health Podcast will empower you with a fascinating scientific connection between your brain, food, and the gut. Come join us. We welcome you. Hello, friends, and welcome to the Gut Health Podcast. We are your hosts. I'm Kate Scarlotta, a GI dietician.

Dr. Megan Riehl 0:45

And I'm Dr. Megan Real, a GI psychologist. Welcome to part two of our two-part series on irritable bowel syndrome with diarrhea predominance or IBSD.

Kate Scarlata, MPH, RDN 0:56

That's right, Dr. Riehl. Today we're getting in the weeds again with IBSD. And in this episode, we're going to be talking to a patient. Today's guest is Beth Rosen, and she is an IBSD patient as well as a GI dietician expert. So let me introduce my friend and colleague, one of my favorite people in the whole GI space, I have to say. And this is my friend too. Your friend too. We all want to be friends with Beth Rosen. She's just a beautiful human being. And she has her master's degree as a registered dietitian, and she's a weight-inclusive registered dietitian that specializes in gastrointestinal nutrition and disordered eating. She has nearly 30 years of experience and has helped clients manage conditions such as irritable bowel syndrome, small intestinal bacterial overgrowth, reflux, and gastroparesis. She also is known for educating health professionals via webinars, national and international conferences, and peer supervision. Beth is the RD Medical Education Lead for OSHI Health, a whole-person GI healthcare company. She's the co-founder of the EDGI training project and co-author of comprehensive medical nutrition therapy for co-occurring gastrointestinal and eating disorders. Her book for patients recently published is called Gut Goals: a practical guide for managing IBS. Learn more at Bethrosenrd.com.

Dr. Megan Riehl 2:36

Thanks for joining us, Beth. We're so excited to have you here.

Beth Rosen 2:40

Thanks for having me.

Beth’s Long Road To Diagnosis

Kate Scarlata, MPH, RDN 2:41

Yay! So let's start. I'd love to just go right into your personal story with your IBSD diagnosis and you know what went right and what mishaps maybe happened during the diagnosis process or what could have been executed better for you.

Self Advocacy And Building Hope

Beth Rosen 3:00

And you said what went right, I was like, nothing. At least in the beginning, it felt that way. So my IBS story started with an infection, as many do, but my infection was C diff, which led me to the ER because I couldn't stay off the toilet. And when I was there, they referred me to a gastroenterologist for further testing. And that's where they diagnosed me with C. diff was like after the fact. And that physician decided that that was it. Just give me some drugs and send me on my way. A couple weeks later, I was like, I don't feel any better. And so I went back and he said, go off of gluten, go off of dairy. So I did that. Didn't feel any better. You know, as the dietitian, I started cutting foods out, saying, maybe it's food, maybe it's food. Got down to like pita crackers and chicken and potatoes, right? And that's exactly what we don't want our patients to do. And I did that because it was really scary to eat. My GI system had been through the ringer with this infection and nothing was feeling better. So he had me come in. He decided he was going to do an endoscopy. Not sure why he chose the endoscopy over the colonoscopy, but chose an endoscopy, did the endoscopy, did not do any biopsies, said it looked great, you know, red flags for the providers here that if you're going in, rule out celiac disease. But he'd already taken me off gluten, so who knows, right? So came back, he said nothing's wrong. And the last straw for me was when I woke up, they gave me toast with butter. And I was like, You said no dairy, you said no wheat. This is what you're offering me. So I was like, I don't trust you. Switch doctors. That doctor said, no, you need a colonoscopy. This is probably like 15 months after my first round of this. So go back, she does the colonoscopy, and she says, Oh, by the way, you still have C diff. I must have taken a still sample, don't remember. So we treated the C diff again, but I still wasn't feeling well. And then I started to go to her like every six weeks. She'd have me come in for a checkup, check-in. I would still have these symptoms. She'd say, Well, you know, it's probably IBS, or it's what she said is post-infectious IBS, it'll probably last two years and it will go away. Okay. So here I am at like the 18-month mark, then the 24-month mark, and I'm still going through this. Then she did a test to test my TTG IgA, and it was very elevated. She told me that I had non-celiac wheat sensitivity. I don't know if she knew how I didn't have celiac disease since that was never tested. And I said, No, I don't, and went home having the biggest bowl of pasta. Should not have done that. That was not a good idea to be the rebel with the food. P.S. I do have some wheat sensitivity. So that was not a good idea. Or gluten sensitivity, actually, because it's more than wheat, it's barley too. And then after a while of going to her and being like, Why am I showing up every six weeks and she's not helping me? I left her practice. I believe there was one more in between, but I'm not sure. But I then I ended up with this other doctor that a friend who was a nurse said, You should go work with him. He's great. So I went to him and this is where things changed for me. He said to me, You're not gonna get better. This is a chronic disease. Like there is no cure for what you have. And I cried in his office. He said, But, but we're gonna find some tools that help you to manage your symptoms so you can feel good. He said, You don't have to live at a seven or eight pain level anymore. We can get you down to a one or two. And that sort of changed my whole perspective on what I was dealing with. At that point, it was like four years already. I had been through the ringer. I still had like had bloating and gas and urgency every single day. I just felt like, you know, fatigue from all of this. And he was the first person who said, let's just try some of these things and see if we can manage your symptoms and so you can have a life. And that was sort of the beginning. Oh, one step back. That third doctor was in Manhattan. I went to the city, you know, to go to like, I'm not gonna say who, but I went to a doctor, and that doctor said, Oh, you should see this dietitian. I was like, I don't need to see a dietitian, I am the dietitian. It was Tamara. It was Tamara Duker Freuman. So I was like, I don't need to see. And when I told Tamara about this, she said, Oh, I was a baby GI dietitian, I wouldn't have been able to do anything at that point. So that's sort of like the gist of you know my story. But it took a good, I would say four years, maybe even five years, to get to a point where somebody could help me get through a day without pain, without bloating, without discomfort. And I still see him to this day. And that was, you know, 15 years ago.

Dr. Megan Riehl 7:42

So what's so remarkable is here you are, you're also in your own clinical practice helping other patients, helping people. And you are a highly educated, well-resourced individual. And it took this long for you. And, you know, I think we can reflect on the privilege of that, and then also why your story is so important that you have to advocate for yourself and gather evidence-based information and resources. And how did you not give up?

Beth Rosen 8:15

Well, you know me, we're friends. I'm sort of sort of a tough cookie, right? But the other piece of it was if this is happening to me, and just like you said, if this is happening to me, what's happening to people that didn't go to school for nutrition, that don't speak up in a doctor's office, that don't know how to advocate for themselves, that won't switch doctor's offices until they get the answers that will help them, right? And I'm not advocating that everybody goes to four doctors, right? But it was at a time when it was like, you know, the late aughts and people didn't know a lot about GI. And a lot of it was it's in your head, or you should see a therapist, or right? It was, or it was spastic colon. It wasn't even IBS, you know, a lot of that, dating myself here. But for me, I felt like I'm not gonna let this happen to other people. I need to pivot my practice, focus on this GI stuff, and figure out how to help somebody not take this long to get better. Absolutely. And that's how I met Kate.

Dr. Megan Riehl 9:14

Yeah, the GOATs of GI nutrition really, too, are right here. What do you say to other patients nowadays with a recent diagnosis? What are some of the ways that you instill this hope and really compassion? Like we have to have so much compassion for any individual's journey. And then what are some of the survival skills that you use and that you coach your patients on?

Common Triggers Food Coffee Enzymes

Beth Rosen 9:41

Yeah, I would say with my own patients, I sort of use what my doctor had said to me, which was yes, this is a chronic illness, but you do not have to be in pain all the time or uncomfortable all the time. And we can build you a toolbox so that you have the tools that you need to manage symptoms when you have them. And we can also find ways to maybe reduce the duration of a flare or the intensity of a flare or the number of flares you have in a period of time if we know what's triggering them, right? And you'll always have them because IBS, you're gonna have them, but how can we make them less scary? How can we gather as much information about the individual's body and how it reacts to food, to stress, to anxiety, to sleep, right? All those things and come up with what's their toolbox. And that's sort of how I guide them. But I also instill in patients a sense of advocating for themselves. I do that mostly through having them create what I call an IBS story. So I want them to create a document, however they want to keep it, they can, but write down the narrative of how this all started. Write down what you've tried and what's worked, what you've tried and hasn't worked. And that could be diet, that could be medication, that could be apps, that could be something you saw on TikTok. Write it down and write down everything and write down potential triggers, what you think might be triggering you. Even if it seems outlandish, write it down. And then that's a document you can hand over or upload, depending on you know how your doctor works, to say, here's my story, take a look at this, and then let's hit the ground running from here, rather than starting from the beginning. Because that's what was happening to me with the second doctor, who just kept starting from the beginning every time I would see her. So I didn't want that to happen to others.

Kate Scarlata, MPH, RDN 11:27

Such excellent advice. And you know, we've talked to various IBS experts and gastroenterologists. Dr. Brenner comes to mind and he's always talking about the triggers. What are the triggers that really can help inform which tools in the toolbox he's gonna start to engage first? So I think having an individual write those particular triggers in their own story is so, so helpful. And you know, as dietitians in the GI space and just looking over the data, we know that, you know, the bulk of patients with IBS describe or perceive food as a trigger. Just eating can be a trigger, never mind, you know, what type of food it is. So we're not surprised when people say food is a trigger. And some people identify the right foods and sometimes they don't, you know, especially when I think, you know, with your case, it was gluten and dairy. Those are big groups of foods and they have FODMAPs in them, which are carbohydrates, and then gluten is a protein, and then dairy really encompasses a larger group, not just lactose. So it can become so confusing for patients, especially when they just start taking out huge food groups. But in your experience as a patient, but also as a GI provider, have you found certain foods and beverages that are just common across, more common to trigger symptoms? Or is it really one size fits all?

Beth Rosen 12:57

I think there are some common ones. And then I think there are outliers for a lot of people. And the most common ones I see are wheat or fructans, right? Wheat, onions, garlic, and dairy, but the lactose in the dairy. So not the hard cheeses or any of those things, but like the, you know, the lactose-based ones. I see those most frequently, but that doesn't mean that I don't go through a form of checking the rest of the diet. Because if somebody says to me, every time I eat X, Y, and Z, I get symptoms, I'm gonna believe them, right? Right. And so I'm gonna look to see, well, why is it? Are you putting something on there? Are you are you marinating with something? Are you seasoning with something? What is about that food that's happening, you know, that's causing symptoms?

Kate Scarlata, MPH, RDN 13:40

So important. I remember sitting in a in clinic and I had a mom and daughter, and watermelon came up. And the mom's like, it's just water, you know, and I'm like, what? You know, it does have some FODMAP carbohydrates, and there could be a link here. And it was just an interesting one that she was not really necessarily getting the support that it could be something in watermelon, since water is the primary ingredient.

Beth Rosen 14:05

But you know, watermelon's one of my triggers. I know I can have a slice of it, but if I go more than a slice, I'm gonna feel it. Yeah, you know, there's certain things that, like, if you know your tolerance level, you can enjoy, right? Or then, you know, some of the other tools are using digestive enzymes if they exist for the certain foods. So, you know, unfortunately, in my case, I've really been able to test that it's the gluten and not the fructans. So there is no enzyme for that yet. One day, maybe I can have that again. Yeah. But right now, I can use certain enzymes so that I can have onions and I can have ice cream, and that makes a big difference.

Kate Scarlata, MPH, RDN 14:44

Absolutely. Not down to pita chips and three foods like the the old days, you know. You can see how patients living with this condition, you know, just trying to control the controllables and diet seems to be that top one, but it can really lead you down a slippery slope of not nourishing your body adequately, right?

Beth Rosen 15:06

For sure, for sure. I think like food does play a role, and we think that the food that's going in our body automatically plays a role, right? But then there are other things that can play a role too. But as a dietitian, it's gonna be the first thing I look at.

Dr. Megan Riehl 15:19

Right. Caffeine is another one that I'm always cognizant of. So, you know, my patients that have horrible morning diarrhea, but then I'm asking, you know, what's your caffeine consumption? And if it's a strong cup of coffee. And and this is a tip that I always kind of look at is different coffee beans are going to have different levels of caffeine. So, you know, your run-of-the-mill, pick it off the shelf, coffee is probably gonna be lower in caffeine, and then some of those like rich beans are higher. And so 325 milligrams a day is usually the average that we would tell people to kind of be mindful of. But if after, you know, every coffee you have, you're running to the bathroom and then what we put in it, the sugar, the whipped cream, the additives, it's just one of those things to be mindful of. Absolutely.

Beth Rosen 16:11

There's also an acid in coffee that can set off your GI system. So even if it's decaf for some people, it's enough to turn everything on if they're sensitive to the acid in coffee.

Kate Scarlata, MPH, RDN 16:22

That's a really good point, right? And I think as a dietitian, we know to ask those questions, right? It's like, oh, is it all coffee or does it happen with decaf? And then you can start teasing out things that might be other components. I mean, food's complicated, you know? Wheat has gluten, fructans, insoluble fiber, bran, you know, so many different things. So dietitians are really in the right spot to help tease out some of those components and figure out which part of it is tripping the symptoms.

Dining Out Without Missing Life

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Dr. Megan Riehl 17:44

So, Beth, what are some of your favorite hacks for dining out? Because this is another one of the things where people's lives just become more isolative. You're avoiding going out because you don't want to deal with the symptoms. But we always like to encourage people that we can get you there. But what are some of your favorite tips for helping people when they're out and about?

Beth Rosen 18:05

Well, again, I'm going to use that word advocate, right? So speak up for yourself. If you're going out with a group, maybe you're the one who chooses a restaurant so that you know that there's an option there for you. You can always call a restaurant during off hours and ask can they accommodate your sensitivities, whatever they might be. And also you could check the menu ahead of time, usually online nowadays, and see what's there. And if nothing else, you can usually get a grilled piece of meat or fish or chicken, and you can get steamed vegetables, and you can get potatoes, and all of those things are low-to-trigger people for the most part. I usually tell people, you can say to the kitchen staff, I challenge you to make me the best dish without using garlic and onion, right? Use every spice and seasoning you can find, but just skip those two if those are, you know, your trigger. They're not triggers for everybody, but for some they are. And then another fact is if you know what your triggers are and there are digestive enzymes that can help you, bring them with you. Enjoy the meal, have the thing, right? Because, like with dairy, for me, I have a purse full of lactase pills. They're in my car. I bring them everywhere. Just on the off chance, there might be something I want to taste or try. I don't want to be left out of it.

Travel And Dating With IBS-D

Kate Scarlata, MPH, RDN 19:18

Yeah. And why play around with it? When there's an enzyme that's going to help you digest that food component that's can trip you up and cause a mad dash to the bathroom. Like, why go there? There are enzymes that can help your body digest them. So yeah, use all resources so you can eat as much as possible and enjoy the ice cream if you want it, right? Right. Liberalize that diet. Liberalize the diet and find joy in food again, right? So let's talk about traveling, dating. I know you've been with your, you've been married for quite some time. So maybe just think I know. My husband wouldn't be happy if we were talking about dating. Yeah, just to just imagine, imagine. You could be dating him, going on a date with him. Any tips or tricks to help navigate traveling or dating if you're a young person out on a date with living with IBSD?

Speaker 20:14

Yeah, traveling, I think, you know, is to make sure you bring your tools with you. We were just chatting before this about when we go to conferences, how we pack our oatmeal, because it just makes it easier that if you can't find a breakfast that fits for you, there's something in your room you can use a coffee maker to make hot water and have, you know, some oats. But I also think when if you're traveling, say you're going on an airplane to bring with you, I like to use chewable simethicone or what's in Gas X to sort of help with when you get bloated from being on a plane, right? Because that air pressure, the pressurized plane, take a couple of those, always be hydrated. Water is a great thing to have with you. There's just so many options. And I also think, you know, when you're traveling by car to make sure that you pack food with you if you don't know along the route what's going to be available. But if you do know, make sure to stop and and try those things and enjoy some of them. There's there's options at a lot of rest stops, even if it's just trail mix, right? Right? Nuts is always a good choice. There's very few people who don't, unless you have an allergy, have an intolerance to those. So that's always always available at rest stops. And then for dating, don't do it if you're married.

Kate Scarlata, MPH, RDN 21:24

Good tip, good tip.

Beth Rosen 21:26

Right. I'm of the the idea to be, you know, super open, but I also haven't dated in over 30 years, so I don't know if it's the case. But I might say, hey, I have some food sensitivities. So, you know, if we're going someplace, can we just keep this in mind? You know, I think dealing with the GI troubles later on is you know a little bit more something to navigate. But I think, you know, with first or second dates, going to a restaurant is like asking, saying, can we pick a place where I can choose something? Because I have food sensitivities.

Lived Experience And Better Care

Dr. Megan Riehl 21:57

Yeah, I agree. Yeah, that goes along with social activity. You know, I have patients that are retired and they want to go out with the pickleball group afterwards and they're still just a little bit nervous about how to say, you know, what their needs are and how to explain themselves. And I always kind of walk it back a little bit to say, you can say, you know, I have a GI condition and I just have to be a little bit more mindful about what I eat. And that's okay. You don't have to pour out your medical history to everybody that you're socializing with. But yeah, exactly to your point, advocating for yourself, having some language that you've pre-thought about a little bit so you don't feel like you're bumbling your words and saying too much and getting flustered and because that stress is going to worsen your symptoms anyway, or maybe even tick off the symptoms. Or we hope that this information is giving you just food for thought and some language that you can use. So, with that transition, I just want to kind of again acknowledge you're a patient, you're a provider. How do you think this lived experience that you have has impacted you when you're engaging with both maybe your patients and other clinicians in the field?

Beth Rosen 23:05

I think I come to the patient side with a lot of empathy because I've been there. I am there because you know I still have IBS. So I can say, oh, this worked or that didn't work. I always use me as the guinea pig. Of course, I use evidence-based resources first before I'll, you know, try something. But then if there's a new product on the market, I'll try it myself. So if somebody says, Oh, how do you use that? I can say, Oh, this is how you do it, or this is what it tastes like, or this is what it feels like, or that kind of thing. Right. And that goes along with being able to understand where they are because I I've been there. So I think that helps to sort of say you're not alone. There are other people that have this, including me. And I, my life is fine. Yeah, do I get gassy? Do I hate pants? Yeah, but you know, it comes and goes, and and I use my tools to manage it.

Kate Scarlata, MPH, RDN 23:53

Because there's nothing like that, like lived experience, I think, sometimes for patients to really believe you. You know, it establishes this like kind of trust and rapport just by feeling connected in that similarity or that lived experience a little bit. You know, also as a GI patient, you know, I'm can share my lived experience as well. And I just, I feel like it does provide this little like, you get it. You get my experience. You know, you're not just saying like, oh, it's hard. You're like, it is hard. I, you know, I understand. So it does, you know, resonate with patients for sure.

Dr. Megan Riehl 24:30

The only other aspect of the question was are there things that you have found really resonate when you talk to another GI clinician? Like things that you want them to know, either about the role of dietetics or advocating for other patients with IBS. Like, what are some of those clinical pearls that maybe you've shared that the clinician goes, ah, okay.

Beth Rosen 24:52

I think the biggest one is sharing what my fourth and final doctor had said to me, which is this is chronic, but it doesn't mean that you can't feel good in your body. And I think sometimes clinicians can miss the mark when it comes to IBS, right? So they might go through the room four criteria and look and see, okay, yes, they have XYZ. And then they might do the test to sort of rule out the alarm features, you know, and make sure that they don't have any of those things. And a lot of times they'll come back and say, everything looks good, right? But as somebody who's been through that, it doesn't feel good to hear that because you want to have a concrete answer. And unfortunately, with IBS, there isn't a biomarker. It's do you have pain? Do you have a change in your frequency of stools? Do you have a change in the appearance of the stools? And do you not have celiac disease, IBD, and all the others? And then, yeah, then this is IBS, right? And so to have somebody say, Oh, you had a colonoscopy, it all looks great. Like, yes, that's a good thing to hear that you don't have cancer, god forbid, but it also would be nice to hear, I didn't see anything on your colonoscopy. What that means is this is most likely IBS because it's not structural, there's nothing wrong in there, which means it's probably functional. That's sort of what I would like if I had to do it all over again. I would have liked to hear from my providers that like nothing's in there and that's a good thing, but this is why, because what you're experiencing is functional.

Dr. Megan Riehl 26:21

Confident diagnosis, and here's a plan. Here's our roadmap. Yeah.

Kate Scarlata, MPH, RDN 26:25

Yes. And you will feel better in your body. We have tools in your toolbox. I mean, there's so many things we can say that can help navigate this. It's not like, oh, you have IBS, good luck, you know. Well, that's the first doctor said that. I know. I know. It's uh a wild west sometimes out there for patients for sure. It's gotten better.

Top Five IBS-D Interventions

Beth Rosen 26:48

It's not as bad as it was back in the you know, offs, but yeah, hopefully there's more information, and providers are doing a better job of supporting these patients.

Kate Scarlata, MPH, RDN 26:59

Totally agree. And I think, you know, I've been doing this for a long time. And all we had really was have fiber, see you later. And now every time we go to conferences, it's IBS is a big section in these conferences and the research and the multidisciplinary approach. I mean, this isn't something that we've been, GI dietitians weren't really in existence. You know, there were people working in GI, but now we've really got this educational platform to get dietitians. We have GI psychologists, we have a team. And there's so many components to IBS, you know, it's not just diet and it's not just meds, and there's lots of factors that, as we all know here that play a role. So when you think about therapeutic interventions for IBSD, do you have like your top five? And I know everyone's different. This is a very individualized diagnosis, but are there five or so go-to sort of lifestyle or nutrition approaches that you find are your go-to's?

Beth Rosen 28:02

Probably. So I'll I'll start and see if I get to five. I think I would get to five. So the first one would be like regular and adequate meals, right? Because I think if people are underfed, that can play a role in their GI health. So making sure people are fed regularly and adequately, they're getting all their nutrients that the, you know, that we're checking for nutrition adequacy in their meals. I think that's a big piece to it. Because people have been through like what I've been through and they cut their diet down to three or four things, they're not well nourished. And so fixing that piece is really the first piece. The second piece, I think, is targeted fiber, right? So there's a bunch of different kinds of fiber. We're not going to go into it, but finding the fiber that works for the type of IBS that the person has, maybe a fiber that supports the microbiome, looking for something like that, right? And then I guess the third one is you can't have fiber without fluid. You can't have fluid without fiber. They're buddies, right? You need to hydrate that fiber, at least in many people, you're using the soluble kind. So you do need to hydrate that fiber, making sure people are well hydrated. I guess that goes along with the first one too, but those are like the top three, right? It's like nutrition, fiber, fluid. Then the next one would be FODMAPs. It's just my first line always. I don't think it needs to be the full spectrum diet anymore. I think we've gotten to a place where we can modify it to be less restrictive, where we can use digestive enzymes in some cases, where we can use a more gentler approach, or, you know, cherry picking, depending on a person. But I still think it's a great tool as long as it's used correctly for the person and you know where they are in their health journey. And then I guess the fifth one would be in Megan's wheelhouse, which is like the gut-brain connection, acknowledging that like stress plays a role, sleep plays a role, gut-directed hypnotherapy is a good tool, deep belly breathing, things you can do, like sitting at your desk or at a traffic stop, you know, a light and just breathe, right? Some of those things. You know, we've been to a couple of conferences where Megan comes in at the end and sort of guides us through meditation that just sort of like gets you through like that after lunch yuck in the gut. Just feels good. Yeah. So I definitely add that in, you know, and tell my patients about those tools as well.

Dr. Megan Riehl 30:16

Well, thank you for the breathing meditation, stress management shout out. I think especially with IBS diarrhea predominant, learning diaphragmatic breathing is so beneficial because it's a tool that can calm and soothe in those moments of urgency. So when you are, you know, five minutes from a rest stop and you feel like you're gonna poop yourself, starting to activate your body's relaxation response with diaphragmatic breathing has saved many a patient from even just the perception that they're gonna have an accident. They might not actually have an accident. The majority of patients with IBSD will not actually have an accident. But having that as a tool in the back pocket can be very helpful. So you can Google a good demonstration of that

Kate Scarlata, MPH, RDN 31:02

with Dr. Riehl on YouTube.

Kate Scarlata, MPH, RDN 31:04

We'll link it in the show notes.

Speed Round Plus Final Takeaways

Dr. Megan Riehl 31:08

Well, you did. You hit five great tips there, and we we appreciate your insights. And now we get to do a very fun speed round. So we're gonna ask you five questions and you just give us a very quick answer, and we'll get to know you a little bit more. So I'm gonna kick things off with your favorite way to unwind after a busy work day.

Beth Rosen 31:29

I like to walk my dogs separately because they're both giants and they will take me down if I take them together. And then I like to come home and knit.

Kate Scarlata, MPH, RDN 31:36

Nice. Oh, I love that. You know, we've had a lot of dog lovers on this show, haven't we? I can relate to that. Link the dog pictures in the show notes. Yeah. Exactly. Exactly. If you were not a GI dietitian, what would you be?

Beth Rosen 31:53

You know, I dream about this, but uh, you know, it won't ever happen. But I'd love to have like a maker space where like everyone who wants to be like crafty and creative can come and like experiment with different kinds of like materials and just like make stuff. I love that.

Kate Scarlata, MPH, RDN 32:06

Like that creative energy.

Dr. Megan Riehl 32:07

It's good. Yeah, never say never. Salty snack or sweet dessert.

Beth Rosen 32:13

Oh, sweet chocolate. Yes, thank you.

Kate Scarlata, MPH, RDN 32:16

I thought you'd be salty.

Beth Rosen 32:19

Really?

Kate Scarlata, MPH, RDN 32:19

Yeah, I don't know why.

Beth Rosen 32:20

That's just my personality.

Kate Scarlata, MPH, RDN 32:21

Yeah, right, right. All right. So is bathroom humor funny or not so much?

Beth Rosen 32:28

Oh, it's funny. It's funny. I mean, how could you be a GI dietitian if it's not funny? And I've got poop art hanging on my walls in my office. Exactly.

Kate Scarlata, MPH, RDN 32:37

I'm with you, girl. I'm with you.

Dr. Megan Riehl 32:39

All right, and a beach vacay or a city trip?

Beth Rosen 32:43

I would say that in my 20s and 30s it would definitely have been beach, but now it's city. Now I want to go explore.

Dr. Megan Riehl 32:49

All right. Perfect. And that IBS is well controlled. So, you know, like you can explore those cities with reckless abandon.

Beth Rosen 32:58

Keep going and walking across all the cities, trying all the stuff.

Dr. Megan Riehl 33:02

That's wonderful. That's wonderful with your enzymes. Well, we appreciate you joining us today. And, you know, if you're a patient living with IBS, check out Beth's latest book, Gut Goals. And we too. Yes, we're we're all holding it up. We will uh put a link in the show notes for you for this book. And we appreciate all of our listeners and continue to come along on this gut health journey with us.

Kate Scarlata, MPH, RDN 33:32

Absolutely. Thanks for joining us, Beth.

Book Plug And How To Connect

Dr. Megan Riehl 33:34

Thanks for having me. Thank you for joining us as we grow this gut health community. We hope you enjoyed this episode and don't forget to subscribe, rate, and leave us a comment. You can also follow us on social media at the gut health podcast, where we'd love for you to share your thoughts, questions, and experiences. Thanks for tuning in, friends.